Drug Related Deaths in
Wales
Dr Rossana Oretti
Consultant Psychiatrist in Substance
Misuse
B Sc; MB BS; MSc; MRC Psych
LOCAL CONFIDENTIAL REVIEW
PANELS

Who are we?

What is our role?

How do we do it?

What do we achieve?
The Statistics
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Two sources -Office of National Statistics
and International Centre fro Drugs Policy
ONS - Recorded from medical certificates
‘where the underlying cause is poisoning,
drug abuse, or drug dependence and
where any of the substances controlled by
the Misuse of Drugs Act 1971 were
involved’
ONS
2000
2001
2002
2003
Wales
78
92
88
Male
67
76
Female
11
16
2004
2005
Annual
average
109 68
89
87.3
71
92
55
70
71.8
17
17
13
19
15.5
ONS




Data collected from HM Coroners
upon completion of inquest- delays
Latest figures published refer to
2005
Not broken down to local authority
areas
Information needs to be accurate,
timely and specific
ICDP



Annual report
Information
gathered from HM
Coroners – Special
Mortality Register
(np-SAD)
Area specific
2004
2005
Annual
DR per
100,000
Br
14
5
1.5
C/V
1
3
.85
NPT
8
9
8.17
Swansea
NR
NR
N/R
Total
23
17
N/A
History of ‘Panels’




2005- Welsh Assembly Government
published ‘Guidance on Developing
Local Confidential Reviews’
Based on practice in England and
North Wales Substance Misuse
Forum
CSPs should form regional panels
Four panels have been established –
SW, Gwent, NW, Powys
‘Panels’



Supported by two drug related
deaths co-ordinators
Development of an All Wales up-todate register
View to support a National group
Who?


Number of professional and
voluntary bodies
Public health, GP, A/E, Psychiatrists
in SM, Pharmacy, ambulance,
providers, police, probation, social
services and
prison…..coroners….forensic
pathologists
How?



Co-ordinator researches all such
deaths
Post inquest files – sudden death
reports, witness statements, post
mortem results including toxicology
Standard questionnaires are then
sent to all service providers (mental
health, housing etc)
How?


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Individual holistic case studies
developed
Panels then meet for joint analysis of
case studies
Voluntary basis
CASE REVIEW


Male , single, 30 years old, CJS
involvement for 8 years, long history
of alcohol/drug-poor engagement
Conditionally released prison on
20/4/05 having served 1 year of a 2
year sentence for robbery
Case review


Staying in B/B- immediately went on
drinking binge and was hospitalised
overnight- as a result fails to attend
appointment on 21/4/05 with
voluntary agency
On 12/5/06 seen by sister and
reported to be in a depressed state.
On 13/5/05 he visits a friend and
informs him he has taken 3 rocks of
speed, unknown tablets, and
drinking alcohol
Case Review



Returns to friends’ house later in day
in a drunken state and collapses
Pronounced dead when ambulance
arrived
Toxicology found – alcohol,
paracetamol, mirtazepine, cocaine
and metabolite, morphine
Case Review



Cause of death was given as
inhalation of gastric contents and
heroin and alcohol intoxication
Verdict of misadventure
What could have changed
this
outcome?.........................
What for?
Data analysis :
 Inform stakeholders at local, regional
and national levels
 Indicators of drug misuse
patterns/trends so that appropriate
and timely action can be taken
 Recommendations to WAG and
commissioners
Data




NW annual report- 26 deaths in 2006
3 panel areas-since November 2006,
almost 50 DRDs have been reviewed (Aug
04 and July 06)
Not all such deaths but those that could
be easily identified
Have to await completion of inquests
Data
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96% male; 4% female
80% aged between 20-39 years
Three between 15-19 (ecstasy)
35% at defined residential addresses
Further 21% at friends/relatives
Friends/relatives had attempted CPR
in most cases
Data
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36% were currently accessing SM
treatment
Majority had accessed SM treatment
in past
82% unemployed
16% low skilled work
Only 1 in management role
DATA
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30% lived with parents

Only 2 homeless
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11 cases in Swansea, 7=NPT, 6=RCT,
5=Newport
NW = dual diagnosis is more common
DATA
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Heroin was contributory in 47% of deaths
Alcohol 24%
Multiple Drug use 15% (NW = cocaine
becoming more prevalent in toxicology
reports)
Other notable substances included
amphetamine (3), cocaine (3), ecstasy (3)
and methadone (3)
DATA
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Alcohol 1 in 4 deaths
Outside of remit of panels to review
acute deaths directly related to
alcohol
Model could be used
DATA
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Prescribed medication- lack of GP
statements on inquest files
Need to close this gap in order to
understand role
6 deaths – recent release from
prison
5 occurred within a three week
period
Near misses
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Not remit of group per se
Need - collaborative approach/sharing
information, audits, early warning
cascades, care pathways from
ambulance/casualty into treatment for
patient and carers/families, take home
naloxone pilots, police at scene etc.
National Group could make
recommendations on best practice
Conclusions
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Gaps in information – need robust
electronic surveillance system
Engaging professionals
Engaging clients/patients
Engaging carers/families
Fragmented treatment and
communication between services
Prison
Conclusions
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Work in progress – ‘All Wales Drug
Related Deaths Register’
GP statements
Action Learning Groups
SM Action plans
Welsh SM strategy – harm
minimisation
Conclusions


Early warning systems- map problem
areas
Police policy